Any doctors who can tell me about morphine and cancer patients?

[pecanpie]

DH's grandmother died last week. She had lymphoma. We're trying to piece together the few facts we have about her death as we were unfortunately kept at arms length by her main carer, DH's aunt. The more we are piecing together, the more concerned we are getting.

We know she was given various medications including morphine patches, but a few days after her death, a bottle of morphine was found hidden away in her home. We were under the impression that morphine is a controlled substance and that it would only have been administered by a visiting medical practicioner. Is this true? In what circumstances might a bottle of this medication have been left in the home?

Thanks for any help you can give

I'm not a doctor. I know that when my Gran was dying from cancer at home she was on a syringe driver and there were vials of various "controlled drugs" including morphine in our house for the DNs to administer.

What are your concerns? Morphine is a very effective pain killer for many cancer sufferers?

It may have been a liquid oral morphine that is administered by people themselves/carers/relatives for what is often termed breakthrough pain.

A friend of mine has cancer and has alsorts of medicine to take herself at home, including one called oramorphe, which I understand if morphene, its a liquid one.

We're concerned because DH's aunt has a history of substance abuse and because it was squirreled away - we're unsure whether this was for her use or the patient's!! She also seemed keen for a lot of medical care to be withdrawn.

Thanks for your feedback.

I work with district nurses and second what lal123 says. It would usually be destroyed by dns very soon after the patient's death. It all has to be accounted for. It is not carried by the nurses but left in the patient's home. It may be prescribed and collected from the pharmacy by the family, but will only be used if necessary for the patient.

Was it a smalll vial with a white powder in or a medicine bottle with liquid in?

My BIL had Oramorph while he was still at home with cancer. We gave what was left to the doctor at the hospice. My boss even had it for a frozen shoulder last year.

My dh self-administered oramorph (liquid morphine) over a long period of time. Please don't feel instantly concerned about this, and I'm very sorry for your loss. A controlled substance doesn't mean it can only be administered by a health-care professional directly, it means the rules around prescribing and dispensing it are tighter.

How about giving Macmillan a call to discuss your concerns? They are the experts and will be happy to help.

Were the patches Fentanyl? Another very effective painkiller.

Hope this helps - your concerns may indeed be valid but the discovery of this type of drug in your dh's grandmother's house is not an instant marker of anything suspicious.

Macmillan are next on our list as the aunt told them not to come - they notified the GP that they were concerned by this but no further action was taken. We don't know much about the medication to be honest and the morphine has already been handed back to the GP.

Hopefully we're just being overly anxious...

Thanks all for your reassurance.

Macmillan will still be able to talk you through the generalities of medication that's prescribed at such times, which I think might help you?

I don't know the ins and outs, will there be an inquest in such a circumstance?

Hopefully the GP will know whether it was Oramorph/something else - don't know if asking them would help you?

My elderly mother is on patches and Oromorph, she keeps forgetting and reorders it from the surgery so she must have a dozen bottles hidden away throughout the house. Its no big deal and I seriously suggest you do NOT raise this with your aunt.
When patients are dying, they can become confused, angry, scared, emotional and incontinent, it is not how the media portrays it with clean sheets and a beatific smile. It takes an enormous amount of devotion, stress, hard work and love to help someone die gently and with dignity and you will cause a huge amount of unhappiness if you are perceived to be acting maliciously.
I appreciate you felt a little excluded but presumably this was how your aunt wanted to care for her mother. Perhaps she didn't want her to be seen like this so I would urge you to be extremely careful in what you say and how you act. Such behaviour is not at all unusual, honestly.

Oramorph liquid would be a very common thing to find in such circumstances.
It is a controlled substance and is prescribed for administration by the patient.

If it wasn't for the fact that she has also stolen thousand and thousands of pounds from their bank accounts, I might be prepared to accept that the aunt had honest intentions with the care.

So have you spoken to the police about the theft?

Are you worried that she may have been taking the morphine herself? Or administered too much of it?

nowherewoman - yes, we're in the process but DH's grandfather has to verify it and he's obviously having trouble admitting it to the police because she's still his daughter.

Pauline - We think she hid it for her own personal use (we have evidence that she was using tamazopan prescribed to her mother)but a neighbour is starting to have suspicions that she may have administered too much, although we're not sure when she would have had the opportunity. Not a nice assumption to make and can't believe it could actually be possible.

My BIL was on so much morphine in the last few weeks that it was impossible to keep track of,so there was quite a lot left in the house just due to the fact he got through a lot. Oromorph or other would have made your aunt pretty poorly herself if not used to it? Sweats, sickness and even sleeplessness.
Sorry you are in this situation. Hope it gets resolved soon.